Trauma patients are safe to fly 72 hours after tube thoracostomy removal

Background Current recommendations for safe air travel following traumatic pneumothorax are 2-3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus which cite a theoretical risk of recurrence and hypoxia due to decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel. Methods A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a post-removal expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period prior to flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded. Results Seventy-three patients who met inclusion criteria were studied. All were male with a median age of 24 (IQR 22-26), ISS of 30 (IQR 24-38), and chest AIS of 3 (IQR 2-4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 (IQR 3-6) days. The median period between thoracostomy tube removal and flight was 2.5 (IQR 1.5-4) days. Twenty-nine (40%) patients remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported post-flight radiographic or clinical recurrences during the subsequent 30 days. Conclusions Following a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically-ventilated and non-ventilated patients. Level of Evidence Care management, Level V Address for correspondence: David Zonies MD MPH, Oregon Health & Science University, Division of Trauma, Critical Care & Acute Care Surgery, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098, fax 503-494-6519, phone 503-494-5300, zonies@ohsu.edu Conflicts of Interest and Source of Funding: For all authors, no conflicts were declared List of meetings at which the paper was presented: Western Trauma Association, Lake Tahoe, 2016 Disclosures of funding received for this work: None © 2018 Lippincott Williams & Wilkins, Inc.

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